Radiation Therapy. 1. Introduction. 2. Documentation of Compliance. 3. Didactic Competency Requirements. 4. Clinical Competency Requirements

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1 PRIMARY CERTIFICATION DIDACTIC AND CLINICAL COMPETENCY REQUIREMENTS EFFECTIVE JANUARY 2014 Radiation Therapy 1. Introduction Candidates for certification and registration are required to meet the Professional Education Requirements specified in the ARRT Rules and Regulations. ARRT s Radiation Therapy Didactic and Clinical Competency Requirements are one component of the Professional Education Requirements. The requirements are periodically updated based upon a practice analysis which is a systematic process to delineate the job responsibilities typically required of staff radiation therapists. The result of this process is a task inventory which is used to develop the clinical competency requirements (see section 4 below) and the content specifications which serve as the foundation for the didactic competency requirements (see section 3 below) and the examination. 2. Documentation of Compliance To document that the Didactic and Clinical Competency Requirements have been satisfied by a candidate, the program director (and authorized faculty member if required) must sign the ENDORSEMENT SECTION of the Application for Certification and Registration included in the Certification and Registration Handbook. Candidates who complete their educational program during 2014 or 2015 may use either the 2011 Didactic and Clinical Competency Requirements or the 2014 requirements. Candidates who graduate after December 31, 2015 must use the 2014 requirements. 3. Didactic Competency Requirements The purpose of the didactic competency requirements is to verify that individuals had the opportunity to develop fundamental knowledge, integrate theory into practice and hone affective and critical thinking skills required to demonstrate professional competency. Candidates must successfully complete coursework addressing the topics listed in the ARRT Content Specifications for the Radiation Therapy Examination. These topics would typically be covered in a nationally-recognized curriculum such as the ASRT Radiation Therapy Curriculum. Educational programs accredited by a mechanism acceptable to ARRT generally offer education and experience beyond the minimum requirements specified here. 4. Clinical Competency Requirements The purpose of the clinical competency requirements is to verify that individuals certified and registered by the ARRT have demonstrated competency performing the clinical activities fundamental to a particular discipline. Competent performance of these fundamental activities, in conjunction with mastery of the cognitive knowledge and skills covered by the radiation therapy examination, provides the basis for the acquisition of the full range of procedures typically required in a variety of settings. Demonstration of clinical competence means that the candidate has performed the procedure independently, consistently, and effectively during the course of his or her formal education. The following pages identify the specific procedures for the clinical competency requirements. Candidates may wish to use these pages, or their equivalent, to record completion of the requirements. The pages do NOT need to be sent to the ARRT. 1 COPYRIGHT 2014 BY THE AMERICAN REGISTRY OF RADIOLOGIC TECHNOLOGISTS ALL RIGHTS RESERVED.

2 4.1 General Performance Considerations Patient Diversity Demonstration of competence should include variations in patient characteristics such as age, gender, and medical condition Simulated Versus Actual Patient Performance The ARRT requirements specify that certain clinical procedures may be simulated as designated in the specific requirements below. Simulations must meet the following criteria: The candidate must competently demonstrate skills as similar as circumstances permit to the cognitive, psychomotor, and interpersonal domains. The program director must be confident that the skills required to competently perform the simulated task will generalize or transfer to the clinical setting, and, if applicable, the candidate must evaluate related images. Examples of acceptable simulation include: demonstrating CPR on a mannequin; setting up another person for a treatment without actually activating the beam; and evaluating a related portal image from a teaching file Elements of Competence Demonstration of clinical competence requires that the program director or the program director s designee has observed the candidate performing the procedure independently, consistently, and effectively during the course of the candidate s formal educational program Scope of Competence Assessment The following is intended to offer a general guide to competence assessment in each of the three domains. It is recognized that most activities actually fall into more than one domain. Cognitive Domain: As part of providing treatment, candidates should demonstrate their understanding of concepts related to anatomy, physiology, pathology, and dose to critical structures. Candidates should also recognize complications and side-effects commonly associated with each treatment procedure. If facilities have a limited number of treatment options, candidates should also describe alternative treatment procedures (e.g., IMRT, IGRT, stereotactic) and explain how those procedures might apply to a given case. Psychomotor Domain: Candidates should demonstrate competence performing activities such as verifying treatment parameters, setting-up the treatment unit, positioning the patient, monitoring the patient during treatment delivery, and documenting treatment delivery. Interpersonal Domain: Candidates should demonstrate ongoing sensitivity to and compassion for each patient s physical and emotional well-being, interact with members of the radiation therapy treatment team in a positive and productive manner, and maintain high ethical standards. The duration of clinical training may not allow students to follow patients over the entire course of treatment. However, some provision should be made to permit candidates to interact with at least one patient and monitor the patient s progress over the continuum of their treatment planning and delivery. 2

3 4.2 Radiation Therapy Specific Requirements General Patient Care Candidates must have demonstrated competence in all four patient care activities listed below. The activities should be performed on patients whenever possible, but procedures may be demonstrated in a clinical lab environment if state or institutional regulations prohibit candidates from performing the procedures on patients Simulation Procedures Candidates must demonstrate competence in treatment simulation for seven anatomic regions. Either a CT simulator or treatment machine may be used. Requirements specific to CT simulation appear in the appendix. It is expected that the candidate will participate with appropriate personnel at one or more of the following levels of responsibility: perform, discuss, review, or observe (level of participation may depend on state or institutional requirements). All simulation procedures must be demonstrated on patients. Demonstration of competence includes considerations related to radiation safety, equipment operation, patient and equipment monitoring, patient positioning, treatment volume localization, imaging procedures and processing, record keeping, and patient management and education Dosimetry Candidates must demonstrate competence calculating doses for seven treatment set-ups. Calculations should be performed for actual patients; however, calculations may be completed in a clinical lab exercise if demonstration on actual patients is not feasible Treatment Accessory Devices Candidates must demonstrate competence in fabricating four devices Participatory Procedures Candidates must participate in three procedures that may be infrequent but are high-risk procedures. Participation means that the candidate takes an active role in the procedure and understands the critical concepts vital to the success of the procedure. Participation may be performed in a clinical lab exercise if necessary Radiation Treatment Procedures Candidates must demonstrate competence in all 12 of the mandatory procedures and seven of the nine elective procedures. All of the mandatory procedures must be demonstrated on patients. Two electives may be demonstrated in a clinical lab environment. Demonstration of competence does not require actual delivery of treatment dose. Demonstration of competence includes considerations related to radiation safety, equipment operation, patient and equipment monitoring, patient positioning, treatment volume localization, dose to critical structures, imaging procedures and processing, dose verification, record keeping, and patient management and education. 3

4 General Patient Care Procedures CPR-BLS Vital Signs (Blood Pressure, Pulse, Respiration, Temperature) O 2 Administration Patient Transfer Simulation Procedures Brain Head and Neck Chest Breast Abdomen Pelvis Skeletal Dosimetry Single Field Parallel Opposed Fields with Field Shaping Geometric Gap Weighted Fields Wedged Fields Computer Generated Isodose Plan Electron Field Treatment Accessory Devices Custom Block (Electron) Bolus Custom Immobilization Devices for Thorax or Abdomen/Pelvis (e.g., Foaming Agents, Vacuum Bags) Thermoplastic Mold Participatory Procedures Total Body Irradiation (TBI) Craniospinal Brachytherapy Date Completed Competence Verified By 4

5 Radiation Treatment Procedures Mandatory or Elective Brain Mandatory Elective Primary Metastatic Head and Neck Laterals Only Multiple Fields * to include Supraclavicular Chest AP/PA Multiple Fields * Breast Tangentials Only Tangentials with Supraclavicular Date Completed Patient or Simulated Competence Verified By Tangentials with Supraclavicular and Posterior Axilla Boost Tangentials with Supraclavicular and Internal Mammary Abdomen AP/PA ** Multiple Fields Para-Aortic Pelvis AP/PA ** Multiple Field Supine * Multiple Field Prone * Inguinal Skeletal Spine Extremity Electron Fields Single Abutting Fields * Multiple fields may include IMRT. ** AP/PA Abdomen and AP/PA Pelvis does not include treatments for metastatic spine disease. 5

6 Appendix CT Simulation Ensure that candidate follows ALARA. Operate CT scanner, perform daily QA as appropriate (e.g., lasers, phantom scans). Explain procedure to patient, prepare supplies needed for simulation, and monitor patient and equipment during procedure. Position and immobilize patient using available tools and instrumentation as required (e.g., lasers, fiducial markers). Perform CT scan for region of interest; participate in determining treatment fields. Review and discuss CT scan and treatment plan with appropriate personnel. Utilize preset protocols or adjust imaging parameters to obtain optimal images. Mark isocenter and transmit network images to workstation. Record patient position and other required information (e.g., set-up, table position). Manage patient as situation requires, including monitoring for possible contrast reactions. Instruct patient on maintenance of skin marks. 6 V